A thorough understanding of ethics and the ethical guidelines that govern the wo

Aug 5th, 2015
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A thorough understanding of ethics and the ethical guidelines that govern the world of clinical psychology is very important for both the professionals who work in the field, as well as those they seek to treat. The ability to effectively deliver informed consent is a big part of that understanding, in particular with regard to the application of all forms of psychotherapy.

Through the use of Chapter Five (pp. 113-115) in the text, as well as the APA Ethical Principles of Psychologists and Code of Conduct (2010), in at least 250 words, provide a set of guidelines that detail the necessary elements of an effective informed consent form, as it relates to providers of psychotherapy and clinical psychology. You are not required to develop an informed consent form, simply provide an outline of what constitutes effective informed consent.


American Psychological Association. Ethical Principles of Psychologists and Code of Conduct (2010). Retrieved fromhttp://www.apa.org/ethics/code/index.aspx?item=1

Pages 113 – 115


Clinical Psychology: Science, Practice, and Culture

What Makes Multiple Relationships Unethical?

Not every multiple relationship is, by definition, unethical. To help identify the specific elements of multiple relationships that characterize them as unethical, we again turn to Ethical Standard 3.05a:

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical. (American Psychological Association, 2002, p. 1065)

As this standard indicates, there are essentially two criteria for impropriety in a multiple relationship. The first involves impairment in the psychologist; if the dual role with the client makes it difficult for the psychologist to remain objective, competent, or effective, then it should be avoided. The second involves exploitation or harm to the client. Psychologists must always remember that the therapist–client relationship is characterized by unequal power, such that the therapist’s role involves more authority and the client’s role involves more vulnerability, especially as a consequence of some clients’ presenting problems (Pope, 1994; Schank et al., 2003). Thus, ethical psychologists remain vigilant about exploiting or harming clients by clouding or crossing the boundary between professional and nonprofessional relationships. Above all, the client’s well-being, not the psychologist’s own needs, must remain the overriding concern.

As the last line of the standard above indicates, it is possible to engage in a multiple relationship that is neither impairing to the psychologist nor exploitive or harmful to the client. (And in some settings, such as small communities, such multiple relationships may be difficult to avoid. We discuss this in more detail later in this chapter.) However, multiple relationships can be ethically treacherous territory, and clinical psychologists owe it to their clients and themselves to ponder such relationships with caution and foresight. Sometimes, major violations of the ethical standard of multiple relationships are preceded by “a slow process of boundary erosion” (Schank et al., 2003, p. 183). That is, a clinical psychologist may engage in some seemingly harmless, innocuous behavior that doesn’t exactly fall within the professional relationship—labeled by some as a “boundary crossing” (Gabbard, 2009b; Zur, 2007)—and although this behavior is not itself grossly unethical, it can set the stage for future behavior that is. These harmful behaviors are often called “boundary violations” and can cause serious harm to clients, regardless of their initial intentions (Gutheil & Brodsky, 2008; Zur, 2009).

As an example of an ethical “slippery slope” of this type, consider Dr. Greene, a clinical psychologist in private practice. Dr. Greene finishes a therapy session with Annie, a 20-year-old college student, and soon after the session, Dr. Greene walks to his car in the parking lot. On the way, he sees Annie unsuccessfully trying to start her car. He offers her a ride to class, and she accepts. As they drive and chat, Annie realizes that she left her backpack in her car, so Dr. Greene lends her some paper and pens from his briefcase so she will be able to take notes in class. Dr. Greene drops off Annie and doesn’t give his actions a second thought; after all, he was merely being helpful. However, his actions set a precedent with Annie that a certain amount of nonprofessional interaction is acceptable. Soon, their out-of-therapy relationship may involve socializing or dating, which would undoubtedly constitute an unethical circumstance in which Annie could eventually be exploited or harmed. Although such “boundary erosion” is not inevitable (Gottlieb & Younggren, 2009), minor boundary infractions can foster the process. As such, clinical psychologists should give careful thought to certain actions—receiving or giving gifts, sharing food or drink, self-disclosing one’s own thoughts and feelings, borrowing or lending objects, hugging—that may be expected and normal within most interpersonal relationships but may prove detrimental in the clinical relationship (Gabbard, 2009b; Gutheil & Brodsky, 2008; Zur, 2009).


The American Psychological Association’s (2002) code of ethics devotes an entire section of ethical standards to the topic of competence. In general, competent clinical psychologists are those who are sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake (Nagy, 2012).

One specific ethical standard in the section on competence (2.01a) addresses the boundaries of competence: “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience” (American Psychological Association, 2002, p. 1063).

An important implication of this standard is that having a doctoral degree or a license in psychology does not automatically make a psychologist competent for all professional activities. Instead, the psychologist must be specifically competent for the task at hand. As an example, consider Dr. Kumar, a clinical psychologist who attended a doctoral training program in which she specialized in child clinical psychology. All her graduate coursework in psychological testing focused on tests appropriate for children, and in her practice, she commonly uses such tests. Dr. Kumar receives a call from Rick, an adult seeking an intelligence test for himself. Although Dr. Kumar has extensive training and experience with children’s intelligence tests, she lacks training and experience with the adult versions of these tests. Rather than reasoning, “I’m a licensed clinical psychologist, and clinical psychologists give these kinds of tests, so this is within the scope of my practice,” Dr. Kumar takes a more responsible, ethical approach. She understands that she has two options: become adequately competent (through courses, readings, supervision, etc.) before testing adults such as Rick, or refer adults to another clinical psychologist with more suitable competence.

Psychologists not only need to become competent, but they must also remain competent: “Psychologists undertake ongoing efforts to develop and maintain their competence” (Standard 2.03, American Psychological Association, 2002, p. 1064). This standard is consistent with the continuing education regulations of many state licensing boards. That is, to be eligible to renew their licenses, psychologists in many states must attend lectures, participate in workshops, complete readings, or demonstrate in some other way that they are sharpening their professional skills and keeping their knowledge of the field current.

Among the many aspects of competence that clinical psychologists must demonstrate is cultural competence (as discussed extensively in the previous chapter). Ethical Standard 2.01b (American Psychological Association, 2002) states that when

an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services. (pp. 1063–1064)

Ethical psychologists do not assume a “one-size-fits-all” approach to their professional work. Instead, they realize that clients differ in important ways, and they ensure that they have the competence to choose or customize services to suit culturally and demographically diverse clients (Salter & Salter, 2012). Such competence can be obtained in many ways, including through coursework, direct experience, and efforts to increase one’s own self-awareness. Readings sponsored by the American Psychological Association, such as the “Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients” (Division 44, 2000) and “Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations” (American Psychological Association, 1993) can also be important contributors to cultural competence for clinical psychologists.

It is important to note that ethical violations involving cultural incompetence (e.g., actions reflecting racism or sexism) are viewed just as negatively by nonprofessionals as other kinds of ethical violations, such as confidentiality violations and multiple relationships (Brown & Pomerantz, 2011). In other words, cultural competence is not only a wise clinical strategy; it is an essential component of the ethical practice of clinical psychology that can lead to detrimental consequences for clients when violated (Gallardo, Johnson, Parham, & Carter, 2009).

The American Psychological Association’s (2002) code of ethics also recognizes that psychologists’ own personal problems can lessen their competence: “When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties” (Standard 2.06, p. 1064). Of course, personal problems that impede psychologists’ performance can stem from any aspect of their personal or professional lives (Barnett, 2008). On the professional side, the phenomenon of burnout among clinical psychologists has been recognized in recent decades (e.g., Grosch & Olsen, 1995; Morrissette, 2004). Burnout refers to a state of exhaustion that relates to engaging continually in emotionally demanding work that exceeds the normal stresses or psychological “wear and tear” of the job (Pines & Aronson, 1988). Due to the nature of the work they often perform, clinical psychologists can find themselves quite vulnerable to burnout. In one study of more than 500 licensed psychologists practicing therapy (Ackerley, Burnell, Holder, & Kurdek, 1988), more than one third reported that they had experienced high levels of some aspects of burnout, especially emotional exhaustion. In this study, the factors that increased a psychologist’s susceptibility to burnout included feeling overcommitted to clients, having a low sense of control over the therapy, and earning a relatively low salary. A more recent study confirmed that over involvement with clients correlates strongly with burnout, particularly in the form of emotional exhaustion (Lee, Lim, Yang, & Lee, 2011).

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